Friday, July 26, 2013

Breasts and Other "Things"

Sorry, no pictures today.

(1)  Breasts first, naturally

I'm waiting outside for my ride one beautiful morning, and a woman dressed in black exits the building.  I catch a glimpse of her prominent chest as she passes by, and can't help but wonder if she wears black often to avoid attention to her more obvious features.

Men, I'm told, fantasize about breasts, revere them, and women do, too. Some also stare, jeer, and comment unnecessarily.

Some less-than-proud breast owners wish to reduce them, hot and inconvenient as they are, a source of back pain, the subject of much conversation, jest. Who can blame a woman for wanting to reduce?

It isn't the type of thing that dominates my thoughts, and even as a pre-teen, as other girls began to "blossom" and I lagged behind, it didn't bother me. My body image wasn't wonderful (most of us haven't a wonderful body image at any age) but it wasn't bad, that young bod, and got me where I needed to go. People seemed to like me, and when that is the case, most other things don't matter so much, depending upon the degree of most other things. So I don't remember dwelling on these diminutive aspects of myself.

But girls who develop fast and furiously do think about them, initially, perhaps, with pride in what they are given, the design, the substance. Later, however, they might become mortified and annoyed, especially if anyone paws at them, especially if they suffered childhood sexual abuse, not that large-breasted adolescents are more or less at risk.

There's a song by Argent that might help us here, Hold your Head Up. (It is embedded in a second post because I couldn't figure out how to add it to this one.)
Hold your head up, hold your head up, hold your head high. 
Doing that, holding our heads up, we thrust back our shoulders. And when we thrust back our shoulders, we thrust forward those parts in front that for some shall not be mentioned, and for others merit alternative names.

And yet not liking one's breasts, a disrespect of a kind, is a not just a minor body ego sabotage, but an extreme ego sabotage. Because if we can't hold our heads up, fearful of negative attention, our self-esteem is compromised, we are hiding, and hiding implies shame. We aren't helping how we appear to others, either, don't seem proud or confident. Not if we don't hold our heads up. So breast reduction can be essential to healthy living.

I was introduced to breast enhancement, the opposite pole on the redesign-your-body-part continuum, as a therapeutic issue, when a patient (others have followed) considered the procedure and thought the decision important enough to talk about with a mental health professional.

Before making that fateful, painful choice, as part of a decision-making therapy we go over the whys and the why-nots.

I'm finding that a woman who walks in thinking she wants bigger or shapelier breasts will walk out convinced it is a good idea, even more so if she is sure it is someone else who wants them. Women are quite sure that this will make them more attractive (someone has done a good job at this sale, often an older sister or mother) and heaven knows, nothing is more important at the moment.  As a therapeutic issue, it is rich, worthy of three visits minimum prior to making a decision to add hard plastic to an otherwise soft, malleable body part.

An even more intriguing phenomenon, one that goes in the why not basket, is that men have brought this up in therapy, too, men who are taken with particular women, but don't like the enhanced breasts, who don't think harder is better, don't appreciate a less natural form of female breast. They are disappointed when they realize this is what they will have to have and to hold for many years to come--  enhanced, but not exactly better, breasts.

And we can tell, I am told, that once we are onto this, even when a woman is dressed, for she undergoes the pain and suffering to look good in clothes, ironically enough, just as one can see when someone has had a "nose job".

FD, our resident physician tells me that when he sees two breasts, he sees two potential lawsuits.

(2) Anthony Weiner and Sexting

The National Organization of Women wants Anthony Weiner to withdraw from the gubernatorial race.  After all, he promised he would stop sexting and it has come to our attention that he has not.

One need not be a feminist to feel disappointment and even outrage following a leader's exposure as one who is caught sexting, literally with his pants down. Political hopeful Weiner continued to send erotic messages by phone, and they weren't to Mrs. Weiner, rather to better endowed women (it is likely) who saw him as a source of fulfillment of their own exploitative objectives, a source of jobs, likely, and desperate (we see them in this light) to engage in job interviews in this fashion.

Mr. and Mrs. Weiner were supposedly having marital problems at the time. He sexted under the name Carlos Danger, a handle that is fast becoming a hugely popular Facebook alias. (Thanks S.A., or Carlos, for that tip).

Mrs. Weiner is telling the press that she is standing by him. Conan jokes that this means standing over the computer as he "works".

David Letterman advises that before a public figure sexts,  he should ask himself ten questions, the most important:
"What could possibly go wrong?"
What's up with sexting, anyway?

Is it a reflection of a fabulous body ego, pride in a particular part, whichever the part may be, a type of narcissism that begs flattery? It would seem so!  A good body ego, not bad. Not looking for a reduction or an enhancement, just showing off. I enhance this all on my own. Look at me!

And yet, when we're asking for attention, Look at me! it is a sign that we need attention, not that we are psychologically strong and independent, mature, evolved, capable of seeing, focusing upon others. We're not finding our sense of self-satisfaction from within, we still need others to validate us.

Not that we ever won't need validation, but there are degrees of need. The whole point of praising, complimenting intentionally, at times to an extreme, especially while parenting, albeit modified to reflect reality, is that so many of us desperately need it, didn't get enough growing up. One who is sexting is communicating this:
  Ah, so this is one thing that I excel at-- I have a very nice whachamacallit. Let me show you. Is this not fine?
Oy vey.

The sociological impetus for the behavior, the cultural context, is that we are an age of anything goes. There is an old Cole Porter song, Anything Goes, about the roaring twenties that plays in my head on occasion.
In olden days a glimpse of stocking was looked on as something shocking now heaven knows, anything goes. 
How I love that song. Anything goes means that truly, nobody cares what we do. And if they are judging, if they do care, there are enough of us who don't to balance the judgement. Having the freedom to do what we want, to make our own determination of what is right for us, real freedom, independence, is a wonderful feeling, and we have the right to the degree that the law allows, no small detail.

Expressing ourselves, living our own values, is what makes us the most interesting of all creations. It is hugely empowering, being human.

Not that we aren't judged by someone, and that won't feel good. Here I worry that I am judged at this moment for even writing about breasts, penises. We live in a country, most of us live in countries, with puritanical roots, a reason that people are outraged, why they care when their political representatives show the more savage sides of themselves.  Yet, the moral majority may not even be a majority anymore, and sex therapies thrive, meaning interest in sex thrives, better sex, more sex.

Does sexting enhance a sexual relationship? Someone will have to study it.  As instant porn, not love, and it enhances something.

The feminist perspective is that porn objectifies, takes away what makes us three dimensional, with thoughts, feelings, accomplishments, strips is of human, dignity. Arousal via objectification is not love; there is no heart, no allegiance in the act. It is all in the body. Much like seeing, wanting, then eating the perfect pizza. The pizza disappears when it is over.

Maybe we just don't want to know that our leaders gorge on anything, whether or not that is fair.Too much information.

therapydoc

Thursday, July 18, 2013

The Tricks of Sociopathy

There is a how-to. Genetics aren't everything.
Book burning, Nazi Germany, 1933

               I have to preface this by saying that I can only speak from then lens of my own culture, not teach (well) about anyone else’s. Although I would like to say that I could write from the perspective of someone who lived in Japan, or France, or Iraq, it would be warmed over, the experience of another.  So here’s what you get when you read from the perspective of a Jew.
               When some of us mention Hitler we add the words, y’mach sh’mo (sounds-like, rhymes-with y’locked-sh’go), meaning, His name should be obliterated from the face of the earth.  On Tuesday some of your Jewish friends or co-workers might have looked ashen and tired, fasting (yet going to work, which isn't encouraged but necessary sometimes) the fast of T’isha B’Av (sounds-like, rhymes-with mish-uh-b’-ah’v).  It is a long, grueling, 25-hour fast in the dead of summer, beginning at sundown on the eve of the ninth day of a lunar Jewish month, ending as the fires of Jerusalem had begun to wane, the next night. Three weeks before we began to show signs of mourning, the men stopped shaving. Then nine days prior observant Jews showered less, stopped wearing clean clothes (we drop them on the floor as a symbolic gesture). No meat, no music. Mourning.
               Mourning for what?  The loss of the Holy Temples, over two thousand years ago.  Not that's culture.  Every year, same thing.  Jews have other fasts, there are seven in all, but usually, if we get up before dawn and have a bite, they aren't as difficult, and none are as emotionally trying as T’isha B’Av. We had two of these holy places. The Babylonians, then the Romans, destroyed them both, built on the site that Abraham was asked to sacrifice his only son, where a mosque sits at this moment in Jerusalem.  The Jews, lost in battle for the city, were sent packing from Jerusalem, exiled.  Something like the Native-American experience for the likes of Tonto.  
               Now.  A proper fast, for an observant Jew, barring pregnancy or illness (which leaves out quite a few of us) means no water (zero, not even rain), and no food, not even a stick of gum.  No teeth brushing. Not a pretty day, Tisha B’av, between the dirty clothes, the bad breath, the sweat and a little starvation. The point of the fast, surely, to draw attention from the Old Mighty, She should notice we’re serious about redemption and hope for the universe.  No one should suffer, not even Her favorite scapegoat, the Jews.
               The other point, one more in line with therapy, is that we learn empathy. We are in the shoes of a Holocaust survivor, in the shoes of a Holocaust victim, in the shoes of a Ruwandan, an Indian, any indigent who suffers, starves, struggles daily.  One would think that this is empathy, but we learn, if we watch the documentary Imaginary Witness: Hollywood and the Holocaust   that our fast is a very weak approximation of the true horror, the true suffering of one who experienced the Holocaust. Nothing, nothing, nothing compares to this horror.
               Indeed, when Hollywood first took on the task of bringing the Holocaust into the homes of the international media-loving public, it was with trepidation.  The directors and producers of the time trembled at the thought of diluting the experience. Because, after all, to manipulate emotion, to capture our souls, a good film has an arc, and that arc is designed to be watchable, with a beginning, a middle, and an end, preferably a happy ending.
               Like dentistry or any surgery without anesthesia, there is no way to adequately convey the experience unless we have been through it.  And most who went through the Holocaust did not live to talk about it, and those who did were speechless for many years.  No words.
               The story, however, had to be told. So it began with brave attempts, The Mortal Storm, Charlie Chaplan’s The Little Dictator, Judgment at Nuremberg (the movie within the movie) and gradually culminated with War and Remembrance, very vivid, the Pawnbroker, Sophie's Choice, The Producers, Cabaret, and a first a television series, airing soon after Roots, The Holocaust.  That film-- four days in a row of nail-biting--captured one of every two Americans, had us glued to our television sets, a generation of teenagers, at once, newly aware of the Jewish experience in Germany. Then Schindler’s List, and ever since, more Holocaust films and documentaries than ever before, many so new that we can’t even get them on Netflix or Amazon-- each an amazing, sobering snap of life that none of us should miss, not if we wish to empathize with the most devastating experiences known to man.
               Therapists, certainly, need to be able to do this, empathize, if only to the degree that we can, having never been through such a thing.  
               Not to ruin your summer.  Here's a quick history lesson.* We learn empathy from history, too.  


Back in the thirteenth century, the French King, Louis IX, a religious zealot,made the Jews miserable if they didn’t convert. He would attend the baptisms of those who did this voluntarily.
When only 500 of the 3500 Jews in a town chose conversion over the alternative, death, an apostate, Nicholas Donin, came up with the idea that without their holy books, Jews were nothing.  Burn the books, destroy the culture. They will replace it.
Donin found an audience with Pope Gregory IX in Rome. He charged that the Talmud contained blasphemies against Christianity and God. The books were the power behind Jewish refusal to accept the true faith. The books needed to be confiscated, destroyed.
The Pope, convinced, ordered seizure of all copies of the Talmud and examined them. On June 12th a stacked public debate sealed the fate. The rabbis defended the faith, but it was a foregone conclusion that 1200 plus copies of Talmud and related commentaries, all written by hand, some a thousand years old, would be lost forever.

The Jews, of course, were not.  That burning in 1242 included 24 cartloads of books. This didn't stop the people from writing about the event, or rewriting their books. All is recorded by eye-witnesses without iPhones.
By 1306, the French King Philip IV (the Fair) expelled the Jews from all of France, and in Germany, taxation, pogroms, blood libels, inspired them to leave for what was then Palestine, where they had originally been banished on Tisha B’Av, a millennium and a half before.   Rudolph I, not wishing to lose them, declared the Jews personal property and refused to let them leave. They were far too successful.
One doesn’t let a resource like this go so fast.

Then the Spanish Inquisition (Was Columbus Jewish?  Did he have to leave Spain?), the pogroms, and we didn't even talk about the previous Crusades. A people forever on the run.
Then in 1933, Hitler took note, burned classics, not just Jewish books, but any old classic that threatened the worship of Nazi ideology, books by:
 Henri Barbusse, Franz Boas, John Dos Passos, Albert Einstein, Lion Feuchtwanger, Friedrich Förster, Sigmund Freud, John Galsworthy, André Gide, Ernst Glaeser, Maxim Gorki, Werner Hegemann, Ernest Hemingway, Erich Kästner, Helen Keller, Alfred Kerr, Jack London, Emil Ludwig, Heinrich Mann, Thomas Mann, Karl Marx, Hugo Preuss, Marcel Proust, Erich Maria Remarque, Walther Rathenau, Margaret Sanger, Arthur Schnitzler, Upton Sinclair, Kurt Tucholsky, Jakob Wassermann, H.G. Wells, Theodor Wolff, EmiléZola, Arnold Zweig, and Stefan Zweig.
You see, you can learn some of the tricks to sociopathy, it isn't all genetic.
Not to say that Hitler hadn’t an original thought in his head.
therapydoc

*The full story can be found on p. 360, commentary to Kinah 41, the Complete Tishah B’Av service, Artscroll Series. The kinot  are lamentations, sad poems sung in a sad, sing-songy drone)..:

Sunday, July 14, 2013

Outsmarting Anger

First a Story

It doesn't help that between patients this morning, my mother tells me that she's still sick.  It started Saturday, a bug, nothing terribly serious. She looked gray yesterday with make-up.

In anticipation that she might be unable to eat today, before pedaling off to the office at 8:00 a.m. I stopped by her apartment to check her pulse and drop off breakfast, lemonade and jello. That's all any of us get in our family when we have symptoms of gastroenteritis, ala FD's expertise.  It's worked for us forever.

Mom is out cold when I get there early in the morning. After all, no place to go, except maybe the ER, and she doesn't appear to need that. Four various combinations of patient family members at the office later, it is time to check on her again.
Chicago Bike Path June 2013 Spring

How do we interpret the events so far?

I'm stressed, although keeping my cool, not hurrying or riding recklessly to get to the patient.  In my town, although it is considered a biker's town (read flat), if you don't ride cautiously you won't ride for long.

And it is a beautiful day, even at noon when it is ordinarily hot and humid in July. Miraculously, yesterday's humidity is gone and there is a lovely breeze coming from the lake.  I feel that superiority only people who ride bikes can feel-- it doesn't get any better. Runners and sailors feel it, too.

Then guilt sets in for enjoying myself, and I wonder whether or not I love my mother enough.  Shouldn't I  be worried about her falling in the bathroom?

How is it that we humans can feel two very different things simultaneously, worry and happy.  Worry, I posit, is the intellectual feeling of that particular moment. Happy is more sentient, the emotional or physical feeling at the time. We don't get that many great-weather-days in Chicago, so happy overrides worried.

Most of my ride is through parkland on paved paths. Mayor Daley, before Rahm Emanuel succeeded him, made sure bike riders, power walkers, buggy pushers, toddlers on Big Wheels, and he himself, a bicycling enthusiast, could traverse several miles without stopping at a traffic light. .

But once out of the park my last city mile is all traffic, and I have to be more careful, the Sunday drivers are out. Not that there aren't bike paths on the city streets, there are, so technically there should be no problem. Blocking a bike path warrants a steep hundred and fifty dollar fine. Even more, $500 and up, $2000, rumor has it, for those who (a) don't look before they open their car doors or (b) engage in the sport of picking off bike-riders this way. We are a sports town.

So imagine my surprise (not really) that the rules are violated. The first car that blocks my way sends me into traffic, but gets a pass. A few blocks later, a Chevy driver, his elbow hanging out of the driver's window, cell phone attached to his ear, hears me assert,
"You might get a big fine parking in the bike lane."
I'm not exactly a citizen-police type, and in more sane, less stressful moment would never have done this. Blogging about it, btw, one way of working it out. Ours is something like my exchange with the dog people in the park, the ones who used to let their dogs run loose. See that ecosystem post).  The Chevy driver, as I peak at him and ride off, isn't an elegant guy. His belly is hanging over his jeans and his tee-shirt is covered in sweat. Blurting to him is a mistake, we'll see.

He sneers at me as I pass,
"Shut up." A nasty guttural tone. 
I ride off, look back as he shouts the "B" word at me.

It's a beautiful day in the neighborhood, a beautiful day in the neighborhood, won't you be mine.

The crazy thing is that I even considered turning around to explain myself, wanted to tell him that this in his best interest, respecting the law.  But now I have to worry that he may vengefully come after me, veer into my space, knock off that little old lady on her way to take care of an even older little old lady.

I worried so much that I found myself looking back to the point of disorientation, danger, and at one point hopped onto the sidewalk, yes, a violation.

What you need to know:
Outsmarting Anger- Joseph Shrand, Leigh Devine

Occasionally we talk self-help here. It can't just all be about me.  Dr. Joseph Shrand and Leigh Devine, MS, authors of the lovely little book, Outsmarting Anger, might use the story as a teaching example. They would tactfully suggest that I sublimate anger, surely a character trait that will sabotage my sanguine nature in the end.  One day I will blow up for nothing, or displace my anger toward the wrong person, someone who did nothing wrong except maybe be in the wrong place at the wrong time.

Oh! That is what happened, although we might not call my suggestion to respect the bike lane a technical blow-up.

The doctors would be right, probably. But I'm too out of touch with my anger to say.

Anger, we learn from Outsmarting Anger, is the emotion that follows a threat. A threat is someone or something that might compromise our resources, residence, or relationships.  For this lesson alone, the book is on a Number One recommendation for anger management connoisseurs, and who isn't one.

The fellow in the dirty tee, by swearing, threatened my sense of safety, and my resources (the road). I feared for my life, too, my relationship with me.  As you know, fear, an arousal emotion, is a close relative of anger. Shrand and Levine explain how the two connect.  Unconsciously or consciously we fear a potential loss based upon our sensory perception. Then we recognize (cognate) the threat in the form of the other's anger. We respond to protect ourselves in the best way we know how, in kind, with anger.

What else do the Harvard researchers tell us about anger?

Those who can't control theirs have a somewhat immature prefrontal cortex. This makes sense to me, for I've always told my addict patients the same thing, those who can't resist the impulse to use substances, eat too much, gamble, or have lots and lots of sex, little else on the brain.  In those moments of caving to the urge we use a primitive part of the brain, the one that isn't thinking, that operates on auto. Like a dog to a piece of meat.

Stop and think, is the intervention. See yourself as a homo sapien before beginning another cocaine binge. It really, really wasn't fun coming off of it the last time.  But memory for addicts is like memory to women who want to get pregnant again. Not bad the last time, was it, that labor and delivery! A walk in the park.

If our problems with anger are all about an immature prefrontal cortex, how can we hasten its maturity? (This interpretation of scientific findings is rudimentary, but who can stop?!)

Think of another mantra around here, that adults who hate themselves but want to change, should take heart. Adults are quite capable of quick change, more capable than children who may not yet have the biological maturity to abstract, save and review. We have the physiology in place, only need to flex our muscles, establish lasting connections between the brain and the extremities.

Not so fast.

The subtitle of Outsmarting Anger, 7 Strategies for Defusing Our Most Dangerous Emotion refers to a deceptively simple but very useful 7-step treatment plan:

recognize rage, envision envy, sense suspicion, project peace, engage in empathy, and communicate clearly (I tried!).

This sounds simple, but if any of this were simple then we wouldn't have to worry, would we, about people shouting expletives from car windows, wouldn't have to feel that anxiety, disruption, that lingering upset that is bundled with anger, and for some of us fear, for the rest of the day.

We don't have bumper stickers on bicycles, but if we did, life would be so much more fun.

therapydoc 

Sunday, July 07, 2013

The "L" word, Sex

Those of you who read this blog regularly know that I rarely use the "S" word.
That John Lennon Song, Mind Games

And yet, here we are, associating it with the "L" word, Love. Is that even politically correct?

Sex in some relationships has been described as marital glue. It is what keeps many couples together when all else fails. Sometimes, it shouldn't, keep them together. Sometimes we're glad it did.

It sells.  Boy, does sex sell. It would seem that without it, nothing sells.

Twenty-five percent of divorced couples blame sex.

People like me are called upon to treat it, to treat problems with it, problems about it (cheating, sexual assault).  You would think everybody wants it, sex, but that's certainly not true at all.

Some merely want to express love in a physical way, and that it can be, an expression.

We've discussed how to use code to signal one's willingness for it, how that can be romantic.
"Honey, come into the bedroom, I have something I want you to look at."  
Or perhaps better,
"Kids, we're taking a nap.  Keep the fighting down."  
Other posts about it have suggested that problems with the mechanics, especially, are usually problems with communication. It is also difficult to communicate about because what we want feels so . . . private. To communicate about private things we have to feel safe, we have to trust. We all have numerous reasons not to do that, not to trust. Yet trust in a relationship that is sexual is everything.

Ironically, many singles assume sex to be a natural, safe part of their relationship. They trust too much and sometimes get burned, come to therapy to talk about it. That lovely piece of themselves, the part that trusted others in relationships erodes, changes. That is something to mourn.

But it is a coming of age thing, too. We really shouldn't trust just anyone. And trust, guess what-- has to be earned-- usually over time.  Lots of time.

A sex therapy is a type of relationship therapy. Meaning it is about both, trust and communication, that old faithful of any therapy, really.  If a couple can't communicate about how to load a dishwasher, then communicating about their most sensitive desires is going to be difficult, too.

"This way!"
"NO! This way!"

Not loving, not at all.
Oh, let me segue, it's my blog. 
I am always amazed at how the Old Mighty determined the male and female anatomy to be so different. (The Old Mighty is the way my grandfather referred to the Creator of the Universe). She worked it so that we have no intuitive knowledge about how the apparatus (fine, anatomy) of the opposite sex operates, even feels.*  Here we are, so alike, and yet in this difference, and those differences in our brains, we're only able to empathize with one another if we talk pointedly about ourselves. Leave the code at home.

My hunch is that we're made differently because where there is pleasure, cheap, clean, unadulterated pleasure, we are motivated to communicate to share it.

And the beat goes on.

I want to blame television, the movies.  In the media it seems to be all about intercourse, nothing else.  Someone doing someone. Even this language, seriously.  Doing? Think of the scenes you've seen on Madmen or another show. Doesn't the emphasis seem to be on penis-vagina sex, except for an occasional on-your-knees job, a sacrifice to make someone happy.

As a young trainee at Loyola University Medical School's Sexual Dysfunction Clinic in the 80's, I almost fell off my chair when Domeena Renshaw, a pioneer in the field, pronounced,
"Only one in five couples have successful intercourse." (Meaning both partners experience orgasm.)  "We just aren't made that way." (Meaning that we will both be satisfied during intercourse.)
Then she proceeded to show us slides that clearly indicate that the clitoris isn't in a physiological position to be especially excited by the penis. Location, location, location.  During intercourse the clitoris, the female center of arousal, isn't stimulated directly by the penis. The male's sex organ is sexy, certainly unto himself, but not to the clitoris.

Now of course you will argue this, because Mr. P is sexy, and beautiful, and can be involved in the pleasuring process as a willing, delightful participant. And the more compliments he gets, the happier he is, as is his wearer, who enjoys an improved body ego. And that's an important thing, I think, for both partners, loving their bodies and communicating admiration and love for what are probably the strangest parts.

That alone is a pick me up for Mr. P, encourages him to stand up and be counted. (Fine, I'll stop).

Mr. P's self-esteem (I couldn't stop, sorry) falls quickly if he feels the success of the party depends upon him, that the responsibility is all his. Ms. C. feels the same way when the circumstances are reversed.

So sex therapists will discuss this, the importance of relating lovingly, admiringly, giving as well as taking,  participating in a mutual process of pleasuring.  We suggest, too, that because of complementary anatomies, the way we are made, it is foreplay that matters most, not intercourse, no matter how it is demonstrated on television. The director of the show has no need to show the foreplay; the sponsors are waiting.

The largest organ of the body is the skin, and it needs attention in all kinds of places, not just those naughty bits that Monty Python used to tease about. Foreplay is all about that, the rest of the body.

But we can't assume that even this, touching other parts, other areas of skin, will be a good thing. We need permission, an invitation really, to touch someone, even if we're partners. It may be covert permission. We may already have it. After years, some of us merely know. Permission granted. Without permission, some people get very anxious at the very idea, being touched.

So let's say that permission is granted.  There are potential problems, however, permissions aside. In many cases Mr. P will be to blame for not cooperating. We'll talk about that case right now.

A young man, could be you, could be your brother, your son, your friend, calls a therapist for help.  Hopefully, he thinks, this is a sex therapist. The therapist, who has marketed herself with all the right Google key words, might hear that he wants sex therapy but might hedge her advice.
 If you are not in a committed relationship it is likely to be an evaluation, not sex therapy, not from me, anyway
Why? What's this?! It doesn't seem fair at all!  How is someone supposed to get into a committed relationship while being a failure at sex?

Excellent point, which is why we schedule the visit, not wanting to be unfair, and evaluate, maybe even suggest a treatment plan. But these recommendations are likely to have little or nothing to do with the mechanics of sex. They are relationship recommendations.

Our young man has never had real relationship problems, or problems with sex. He has had partners before his current relationship. He does not use drugs or drink. His parents are together and seem happy and he has never heard sex as a dirty word.  In his current relationship he is losing his erection because he is suddenly very anxious while putting on a condom.  He has an anxiety problem, he says, but only about performing in the sack and only in this relationship.

This is pretty common, losing an erection, or in the case of females, losing focus. Men often lose theirs in the process of putting on a condom. Getting back to the party feels like starting over.
So start over, we say. 
Whenever this happens, erections, arousal, drifting away, a couple is instructed to start over.

"And is she helping you at this point, when you both notice what you're labeling as a problem?" asks the therapist.

"What do you mean, helping?" He is lost.

"Well, either emotionally or physically. Either by loving you with words or actions.  Are you telling her what she could do to get you back into this?"

No, of course not.  She is expecting him to get it up.   After all, this is his job. Her pleasure is supposedly within his agency.

It is so backward, I feel. We used to have this expression, not popular, apparently today, not in the age of Fifty Shades of Gray, that you have to be responsible for your own orgasm.

Taking responsibility for one's own climax means many things, among them wanting to feel in the mood when we know our partner is in the mood or certainly will be, preparing mentally and physically for time together. But it is also telling a partner what we want, exactly, when we're actually making love (there's that word). We're the only ones who know the answer to that, to what makes us feel good. It is a nice process, too, a learning experience when we don't know what makes us feel good, when there are two eager learners, working with trial and error.**

The dysfunctional cycle or homeostatic feedback loop of the case:

Two partners, A and B are involved in the love making process, except that only A feels responsible for the success of a "date".  Suddenly:

has trouble with his erection while putting on a condom, or at any other time.

waits for A who is having trouble with Mr. P., who seems to be taking a nap.

A begins to get anxious, fiddling with the condom or worrying that this will never happen. Mr. P isn't waking up.  Wake up, damn it!  Mr. P doesn't cooperate under pressure.

B is becoming impatient, is considering what is on television.

A worries that B is going to abandon him, drop him. The two aren't committed after all. Meanwhile, Mr. P is not looking his best, is nowhere to be found, has disappeared altogether.

B looks at A, accusingly. Well?  When are we going to get back to it? (Note, not What can I do to help?)

A's anxiety rises with every passing second. Mr. P is hardly breathing.

B to A:  Call me when you've fixed this problem.

A's fears are realized. Our young man has learned that he had better fix this or he'll never have a normal relationship. He calls a sex therapist.
What do you mean, Is she helping me with this?  No! Why would she?  
The Beatles liked to sing in the song Mind Games, which I'm pretty sure is about sex, but in code,
Love is the answer.  
Work on that, we say. The rest is commentary.

therapydoc

*Our DNA is approximately 95%  alike, yet we still use the language, the opposite sex..  I think that is because that five percent weigh in when we interact in this way, in a potentially procreative, sexual way.

**This is why some of us recommend sex in the format of a committed relationship. If you assume you have until you are a hundred years old, give or take a few years, to figure it out, there is less stress. Trial and error, lots of words and audible breathing, and this falls into place rather quickly. Oh, and deserved trust, lets not forget.

P. S. John Lennon died December 8, 1980. A fan killed him, I think.  We could comment on that all day long, I suppose.

Monday, July 01, 2013

The Black Hawks Win, and the Gay Pride Parade

They don't seem to have a thing in common, at first glance.
O'Doul's- the non-alcoholic beer

But for an addict, they have everything in common.

(1) The Hawks

I feel pretty lame, and in some ways traitorous, but as a Chicagoan for over half a century, I should have been posting on Facebook like all of my young friends.
Haaaawwwwwkkkkkkkssssss!!!!!!
OMG!  ANOTHER WIN!!!!
THEY DID IT AGAIN!!
And I should have been to a game, and I should have been at the rally, a huge Mardi Gras that many are still talking about. The pictures in the paper make me feel that as a blogger I missed a tremendous photo op. Foiled again.

The Hawks won the Stanley Cup in 2010, too, and the revelry in the city made the angels in Heaven look down and wonder if perhaps they should attend. Nothing could be better.

And indeed, if you looked closely at the celebrations, you would have thought we found Osama bin Laden. No, really, the two don't compare. The only thing that compares with the feeling are other titles, the World Series, the NBA championship. Entire cities can't get out of bed the next day.

Players, fans alike, sodden in beer, the Mayor declared last Friday a Ferris Bueller's Day Off. No self-respecting lawyer worked. Chicagoans, proud of the accomplishment of their team, partied like it was  . . . .2010.

Those of us in my business hear about it up close and personal just a little differently. The desire for social inclusion is very strong. And drinking, as any fool knows, makes socializing much easier. The shy among us develop a personality they never had, sober. Drinking is a lubricant, a way to find that brave, intelligent, funny person inside. Who wouldn't want to do that?

It is also a way to alcohol dependency. What is fascinating is that over-indulging is encouraged in the cooler companies, at least once a month, a perk! Employees are invited to go out on one Friday, a "no-work" day, on the company tab. Drink until you see double, or perhaps aspirate on your pretzels and peanuts.

Sounds like fun. But if you are an alcoholic in recovery, and new on the job especially, wanting to fit in, it isn't fun. It is torture. You go and sip your O'doul's, your non-alcoholic beverage, and you remember how you used to celebrate with your friends merely that it was Friday, because after all, you had worked a full week and that, for many, is a cause for celebration. You are angry-- livid-- that you are the only one out with your colleagues-- not getting high.

Perhaps you remember celebrating the Stanley Cup win by the Hawks in 2010. You don't remember it well, but you do remember the revelry, the communal high. Being cool. Among friends.

If you are in AA, maybe, at that one-Friday-a-month work bash at the trendiest bar, you text your sponsor who writes back, GET OUT OF THERE AND GO TO A MEETING. But you don't want to go to a meeting, don't want to be with those people. You want to be with these people, the ones who are having so much fun. You want to be a part of this party, to be the funny woman, the funny man, that person who is laughing it up.  You don't want to be mature, emotionally excluded, out of the loop, detached, and boring.

If you make it through the afternoon unscathed, you tell your therapist the next week how angry you are that you have to be an addict, that you can't drink, that forevermore you can't party, can't be a part of this wonderful abandon.

The therapist tells you it is good to be angry, good to grieve that loss, because being like this, drinking to abandon, is an attraction to you, even though you know it is very much like being a child, perhaps three-years-old, plus or minus a few. The selfishness, the need for attention, the desire for undivided attention, special attention, is roaring. It was great being three, it was great being a child, but adulthood, finally, has set in.

Welcome to your bar mitzvah, I like to say. We Jews have big (sober, used to be) parties to celebrate becoming a man, a woman. It is a different world, by far, adulthood. A better one, really. You get to drive, not just a car, but your life. Now you are responsible, have to quit blaming everyone else.

Go Hawks.

(2) Gay Pride

I love the gay pride parade, let's get that straight. But like the Stanley Cup celebration, for addicts, it has its downside.

Not to cast aspersions, but some people come to therapy for sex addictions. Not that the percentages of sex addictions (obsessed!) are higher for the sexual minorities, my guess, they are not, but sex addicts, like all others with dependencies, have triggers. One of them is being among others who are, what in my day we would have called, promiscuous.I don't think the word exists anymore.

Most sex addicts are on the internet, not the streets, buying porn, passing it to their friends, or selling it, or they have sunk to other levels. This aside to lend perspective to the idea that being gay and openly looking for love-as-a-one-night-stand is a mere sub-category of sex-addiction. Ministers come to therapists to ask what to tell their straight porn-loving parishioners, or their spouses. So we're not throwing stones on anyone's parade here. An obsession with sex is not a gay thing.

That said, the Gay Pride Parade in Chicago, if you haven't been to one, is a love fest and a must see. The colors, the joy, that feeling, pride, makes all of us happy, and it is so hard to find pride and happiness like this on an average day.

We're Americans, born to a culture with Puritan roots, so being proud of ourselves for merely having a sexual self at all, is hard. Ninety percent of us pray, or used to, according to a Life Magazine poll, not that we can believe that number. But it even if it is fifty percent it is significant. And the gods, last we heard from them, those of us from the Big Three religions, aren't saying that being gay is a good thing.

Gay pride parades in Heaven?  Unlikely. But maybe!

So I ask my gay patients, Are you going to the parade this week?  The newly out of the Ikea armoire are excited. Yes!  Looking forward to being with my people, seeing people who understand. I'm looking forward to openly being proud!

The sex addicted, the ones who handle their feelings by impulsively running off to pick up someone to take someplace to have sex, give a resounding NO!
 Do you know what people do at the parade? They look for someone like me to grope, to follow around, to hook up with. Do you know what that feels like to someone who actually wants to be groped, be followed, be loved?  It is irresistible. So no.  
Proof positive that it isn't necessary to follow the crowd, to be where everyone else seems to want to be. Better, my alcoholics tell me, to figure out who we are, watch it all on television, all the revelry, the parades, and do a little soul searching, maybe, just maybe, think back on some of those memories, the ones that ultimately drive us to therapy.

The memories are the generic form or Antabuse* for every addiction.

therapydoc

*Antabuse is a drug that if you take it before drinking reacts violently with alcohol, makes you physically ill. Some take it when they think they are vulnerable so that they won't drink. Nobody wants to get sick like that and you won't drink if you're very sure that you will.